發(fā)布時(shí)間：2018-02-27 06:33

  本文關(guān)鍵詞： 顱頸交界 腹側(cè)區(qū) 經(jīng)下頜下-咽后入路 顯微解剖 顱頸交界 腹側(cè)區(qū) 枕下極外側(cè)入路 顯微解剖　出處：《山東大學(xué)》2006年博士論文　論文類型：學(xué)位論文

【摘要】：第一部分：經(jīng)下頜下—咽后入路的顯微解剖學(xué)研究 目的：雖然在國(guó)內(nèi)外已有少數(shù)神經(jīng)外科醫(yī)生將經(jīng)下頜下—咽后入路應(yīng)用于臨床，但是該手術(shù)入路在應(yīng)用的過(guò)程中極易造成舌下神經(jīng)、椎動(dòng)脈等重要結(jié)構(gòu)的損傷，從而在很大程度上限制了其在臨床上的應(yīng)用。本研究模擬手術(shù)入路進(jìn)行顯微外科解剖，測(cè)量相關(guān)解剖數(shù)據(jù)并觀察手術(shù)的顯露范圍，旨在提供精確的解剖學(xué)資料以期指導(dǎo)臨床手術(shù)安全順利地進(jìn)行。 方法： 1．標(biāo)本材料及儀器設(shè)備：完整顱底骨性標(biāo)本30例；完整寰、樞椎骨性標(biāo)本各50例；15例(30側(cè))經(jīng)福爾馬林充分固定的國(guó)人成人帶頸(均保留至C_4水平以上)頭顱濕性標(biāo)本，為準(zhǔn)確區(qū)分動(dòng)、靜脈，維持血管正常粗細(xì)和提高照片的拍攝質(zhì)量，所有標(biāo)本均在動(dòng)、靜脈系統(tǒng)內(nèi)分別灌注混有紅色和藍(lán)色染料的乳膠。 2．解剖步驟：模擬經(jīng)下頜下—咽后手術(shù)入路逐層進(jìn)行顯微外科解剖，用數(shù)碼相機(jī)拍攝解剖過(guò)程并測(cè)量有關(guān)的解剖數(shù)據(jù)。①尸頭取仰臥位并向非手術(shù)側(cè)旋轉(zhuǎn)大約30°，，頸過(guò)伸頭架固定。②皮膚切口：與下頜骨平行并在其下緣約2cm處做橫行的皮膚切口，起自乳突尖，于下頜角下方約2cm處轉(zhuǎn)向中線，止于舌骨上方。③切開(kāi)皮膚，顯露并充分游離頸闊肌，與皮膚切口平行，橫行切斷頸闊肌，顯露并充分游離下頜下腺。④向上牽開(kāi)下頜下腺，沿肌腱方向切斷固定于舌骨大翼上的筋膜索帶，使二腹肌肌腱游離，將其牽向上方，顯露舌下神經(jīng)。⑤將舌下神經(jīng)牽向上方，沿舌骨行徑打開(kāi)筋膜直至頸動(dòng)脈鞘，進(jìn)入咽后間隙。⑥用手指觸摸，確定寰椎前結(jié)節(jié)，將椎前間隙內(nèi)的頭長(zhǎng)肌、頸長(zhǎng)肌及筋膜全部清除，顯露寰樞椎表面。⑦磨除寰椎前弓及樞椎齒狀突，顯露枕骨大孔前緣和下斜坡。⑧磨除下斜坡骨質(zhì)，去除寰椎十字韌帶及覆膜，“工”形切開(kāi)硬膜，顯露和觀察硬膜下方的結(jié)構(gòu)。⑨截?cái)嘞骂M骨，將其翻向上方，觀察顯露范圍的擴(kuò)大程度。
[Abstract]:Part one: microanatomical study of transmandibular subpharyngeal approach. Objective: although a few neurosurgeons at home and abroad have applied the submandibular retropharyngeal approach to clinical practice, it is easy to cause damage to the hypoglossal nerve, vertebral artery and other important structures in the course of application. This study simulates the surgical approach for microsurgical anatomy, measures the related anatomical data and observes the exposure range of the operation. The aim is to provide accurate anatomical data to guide the clinical operation safely and smoothly. Methods:. 1. Specimen materials and instrumentation: 30 cases of intact skull base bone specimens, 50 cases of intact atlas and 50 cases of axial bone specimens, 15 cases with 30 sides or 30 sides of intact atlas and axial bone specimens. Adult adult cadaveric specimens with neck (all above C4 level) were fully fixed by formalin. In order to accurately distinguish the arteries and veins, maintain the normal thickness of the blood vessels and improve the quality of the photographs, all specimens were perfused with red and blue dyestuffs respectively in the arteriovenous system. 2. Anatomical steps: the microsurgical anatomy was performed layer by layer by simulated submandibular retropharyngeal approach. The anatomical process was photographed with a digital camera and measured. 1 the cadaveric head took the supine position and rotated about 30 擄to the non-operative side. The cervical extension head frame fixed the 2. 2 incision of the skin: a skin incision parallel to the mandible and transversing about 2 cm below the lower margin. Starting from the mastoid tip, turning to the midline at about 2cm below the mandibular angle, ending at 3. 3 incision above the hyoid, exposing and fully disengaging the latissimus cervicalis, parallel to the incision of the skin, transecting the latissimus cervicalis laterally. Exposing and fully dissociating the submandibular gland from the submandibular gland upward, cutting off the fascial cord band fixed on the great pterygoid of the hyoid bone along the direction of the tendon, leading the tendon of the bicentric muscle to the top, exposing the hypoglossal nerve, leading the hypoglossal nerve to the top, The fascia was opened up to the carotid sheath along the hyoid approach, and the posterior pharyngeal space 6. 6 was touched with the finger to determine the atlas anterior tubercle. The head longus, the cervical longus and the fascia in the prevertebral space were completely removed. Exposure of atlantoaxial surface .7 abrasion of anterior arch and odontoid process of atlas, exposure of anterior margin of occipital foramen and lower Clivus, removal of inferior Clivus bone, removal of cruciate ligament and membrane of atlantoaxial vertebrae, "working" incision of dura, The subdural structure 9. 9 truncated the mandible, turned it over, and observed the extent of the exposure.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2006
【分類號(hào)】：R322

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1 孫基棟;顱頸交界腹側(cè)區(qū)手術(shù)入路的顯微解剖學(xué)研究[D];山東大學(xué);2006年

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